Researchers assessed emergency department (ED) visits for gambling disorders in Ontario before and after legalization of single-event sports betting (August 2021) and the April 2022 expansion that allowed private operators. Ontario's online market now includes 83 sites run by 43 companies; in 2024 Ontarians wagered $82.7 billion through 2.6 million accounts. Over a 14-year period, 757 people generated 952 ED visits where a gambling disorder was recorded; nearly three-quarters were male. Following the market expansion, ED visits for gambling disorders rose sharply, concentrated among younger men: observed visits were 154% higher than expected for males aged 10-29 and 116% higher for males 30-44, while females showed no change.
More than 70% of gambling-disorder ED visits involved another mental health condition or heavy substance use and roughly one-third led to hospital admission, indicating substantial severity. Increases in helpline contacts after expansion could reflect promotional requirements to display support information, but ED visits are not influenced by such promotion, strengthening the link between market expansion and increased severe harm. Researchers and clinicians warn jurisdictions considering similar privatization to weigh these risks and adopt stronger safeguards - restrictions on marketing and higher-risk products, plus better recognition and treatment of gambling-related harms.
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